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Assign code 0 when Surgery of Primary Site is coded in the range of 10-90 (surgery of the primary site was performed) 2 order fluvoxamine 50 mg online anxiety nightmares. Assign a code in the range of 1-8 if Surgery of Primary Site is coded 00 or 98 Note: Referral to cheap fluvoxamine 100 mg on-line anxiety symptoms visual disturbances a surgeon is equivalent to cheap fluvoxamine 50 mg mastercard anxiety symptoms on the body a recommendation for surgery generic 50 mg fluvoxamine free shipping anxiety symptoms child. The treatment plan offered multiple treatment options and the patient selected treatment that did not include surgery of the primary site Example: Prostate cancer patient is offered three treatment options: a. Surgery of the primary site was not performed because it was not part of the planned first course of treatment. Recording that a patient refused the treatment modality means that the patient refused recommended therapy. There is no documentation explaining why surgery was not done Example: the medical record has a recommendation that the patient have surgery. No further information is given; it is unknown if the patient refused surgery or if there were co-morbid conditions that prevented the surgical procedure. Makes a blanket statement that he/she refused all treatment when surgery is a customary option for the primary site/histology. Assign code 1 when surgery is not normally performed for the site/histology Note: Coding Reason for No Surgery of Primary Site as refused? does not affect the coding of the other treatment fields. Code 7 means surgery is exactly what was recommended by the physician and the patient refused. If two treatment alternatives were offered and surgery was not chosen, code Reason no surgery of primary site as 1 [Surgery of the primary site was not performed because it was not part of the planned first-course treatment]. Assign code 8 when surgery is recommended, but it is unknown if the patient actually had the surgery Example: There is documentation in the medical record that the primary care physician referred the patient to a surgical oncologist. Follow-back to the surgical oncologist and primary care physician yields no further information. Assign code 8, it is known that surgery was recommended but there is no information on whether or not the patient actually had the surgical procedure. Determination of the date radiation started may require assistance from the radiation oncologist for consistent coding. Record the date of the first/earliest radiation treatment if radiation was given and recorded as part of the first course of therapy 2. Radiation date should be the same as the Date Therapy Initiated when radiation is the only treatment administered 3. Therefore, it is important to continue follow-up efforts to be certain the complete treatment information is collected. Code Label Definition Blank A valid date value is provided in Date Radiation Started 10 No information No information whatsoever can be inferred from this exceptional value (that is, unknown whether any radiation therapy was given) 11 Not applicable No proper value is applicable in this context. This event occurred, but the date is unknown (that is, radiation therapy administered but the date is unknown). Leave this item blank if Date Radiation Started has a full or partial date recorded 2. Assign code 11 if radiation was not planned or given as part of the first course of therapy or the initial diagnosis was at autopsy 4. Assign code 12 if the Date Radiation Started cannot be determined but the patient did receive first course of radiation 5. Assign code 15 if radiation treatment is planned but has not started and date is not available. If radiation was expected to be given or was planned as part of the first course of therapy, but information was not known if the radiation had been started or had not been started at the time of the most recent follow-up, attempt to follow-up to assure complete information is collected. As information is learned, update this item, Date Radiation Started, and all other radiation items. These data items identify the radiation modality administered during the first, second, and third phase, respectively, of radiation treatment delivered during the first course of treatment. Radiation modality reflects whether a treatment was external beam, brachytherapy, a radioisotope as well as their major subtypes, or a combination of modalities. These data items identify the external beam radiation planning technique used to administer the first, second, and third phase, respectively, of radiation treatment during the first course of treatment. Code Label Description 00 No radiation Radiation therapy was not administered to the patient. These type of treatments are sometimes referred to as electronic brachytherapy or orthovoltage or superficial therapy. Clinical notes may refer to the brand names of low energy x-ray delivery devices. Any external beam modality can be modulated but these generally refer to photon or proton beams. If a treatment is described as stereotactic radiotherapy or radiosurgery with online re-optimization/re-planning, then it should be categorized as online re-optimization or re-planning. If a treatment is described as adaptive? but does not include the descriptor online, this code should not be used. Determination of the external beam planning technique may require assistance from the radiation oncologist to ensure consistent coding. Any one of these changes will generally mean that a new radiation plan will be generated in the treatment planning system and should be coded as a new phase of radiation therapy. Note: Online adaptive therapy? refers to treatment where radiation treatment plans are adapted or updated while a patient is on the treatment table.

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Later pregnancy miscarriage was found in physiotherapists using shortwave diathermy order fluvoxamine 50mg online zantac anxiety symptoms, Kallen et al cheap fluvoxamine 100 mg on line anxiety symptoms for no reason. Miscarriage is also associated with exposed electronic technicians cheap 50mg fluvoxamine amex anxiety symptoms losing weight, Vaughan et al cheap fluvoxamine 50mg otc anxiety symptoms in young males. Male physiotherapists had significant dose-response increases in Ischemic heart disease from both short-wave and microwave exposure, Hamburger et al. Naval technicians exposed to radar during the Korean War were diagnosed with significantly higher cardiovascular disease, p<0. This was particularly related to cases of Arrhythmia and Acute Myocardial Infarction. The consistent elevation and exposure gradient effects were found for Arrhythmia and heart attack but not for atherosclerosis and chronic coronary heart disease. Public Health Conclusions: Multiple published studies show that residential and occupational exposures to electromagnetic fields and radiation results in significant increases, including dose response increases in cancer, reproductive, cardiac and neurological health effects and mortality. This is theoretically predicted and plausible through resonant absorption that is made possible through frequency matching and tuned circuits. Mammals have advanced physiological systems to deal with diurnal and seasonal climate variations. This involves the melatonin/serotonin system communicating with all the vital organs in the body in order to maintain thermal homeostasis. Strong association between sudden infant death syndrome and increments of global geomagnetic activity possible support for the melatonin hypothesis". Overt limbic seizures are associated with concurrent and premidscotophase geomagnetic activity: synchronization by prenocturnal feeding". Increased geomagnetic activity and group aggression in chronic limbic epileptic male rats". Quantitative increases in group aggression in male epileptic rats during increases in geomagnetic activity". Effects of conductivity at various altitudes on resonance frequencies and attenuation". Walleczek, J, 1992: "Electromagnetic field effects on cells of the immune system: the role of calcium signalling". They are also rich repositories of biodiversity and water and providers of ecosystem goods and services on which downstream communities (both regional and global) rely. Realising the importance of mountains as ecosystems of crucial signifcance, the Convention on Biological Diversity specifcally developed a Programme of Work on Mountain Biodiversity in 2004 aimed at reducing the loss of mountain biological diversity at global, regional, and national levels by 2010. Despite these activities, mountains are still facing enormous pressure from various drivers of global change, including climate change. Under the infuence of climate change, mountains are likely to experience wide ranging effects on the environment, natural resources including biodiversity, and socioeconomic conditions. Little is known in detail about the vulnerability of mountain ecosystems to climate change. Intuitively it seems plausible that these regions, where small changes in temperature can turn ice and snow to water, and where extreme slopes lead to rapid changes in climatic zones over small distances, will show marked impacts in terms of biodiversity, water availability, agriculture, and hazards, and that this will have an impact on general human well being. But the nature of the mountains, fragile and poorly accessible landscapes with sparsely scattered settlements and poor infrastructure, means that research and assessment are least just where they are needed most. And this is truest of all for the Hindu Kush-Himalayas, with the highest mountains in the world, situated in developing and least developed countries with few resources for meeting the challenges of developing the detailed scientifc knowledge needed to assess the current situation and likely impacts of climate change. Activities included rapid surveys at country level, thematic workshops, interaction with stakeholders at national and regional levels, and development of technical papers by individual experts in collaboration with institutions that synthesised the available information on the region. A summary of the fndings of the rapid assessment was published in 2009, and is being followed with a series of publication comprising the main vulnerability synthesis report (this publication) and technical papers on the thematic topics climate change projections, biodiversity, wetlands, water resources, hazards, and human wellbeing. Clearly much more, and more precise, information will be needed to corroborate the present fndings. Nevertheless, this series of publications highlights the vulnerability of the Eastern Himalayan ecosystems to climate change as a result of their ecological fragility and economic marginality. It is hoped that it will both inform conservation policy at national and regional levels, and stimulate the coordinated research that is urgently needed. The six technical papers produced on thematic this synthesis report is the outcome of this work. The analysis and of India (North East Indian states, and the Darjeeling hills predictions showing an increase in the magnitude of of West Bengal), southeast Tibet and parts of Yunnan in climate change with altitude (in terms of both temperature China, and northern Myanmar. The study explored the different geo-political and socioeconomic systems, as well impact and future projections of changing climatic as diverse cultures and ethnic groups. Activities included surveys at country level, result of its ecological fragility and economic marginality. Available climate models were used to Many factors contribute to the loss of biodiversity such as develop climate predictions for the region based on the habitat loss and fragmentation, colonisation by invasive species, overexploitation of resources, pollution, nutrient adequate scientifc evidence to determine the impact of loading, and global climate change. Fragmentation and the adaptation mechanisms adopted by the local people loss of habitat directly impinge on the survival of species, and the new opportunities presented. Species challenge for the region is to adapt to the impacts of in high altitude areas especially in the transition zone climate change by integrating responses and adaptation between sub-alpine and alpine are more vulnerable to measures into local level poverty reduction strategies. People see climate to advance our thinking about climate variability and change as a big threat and challenge. They perceive change, and the vulnerability and adaptation of important climate change to be a result of excessive human impact areas, with a view to developing future strategies activity and, to a certain extent, natural cyclical climatic on both conservation and development. The majority of the respondents from the region shortcomings and identifes research gaps in relation associated climate change with foods, landslides, to biodiversity, wetland conservation, the resilience of increases in temperature, land degradation, the drying of ecosystems and their services, and hazards assessment, water sources, pest outbreaks, and food shortages.

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The author relates evidence from other studies that have shown that lighting affects human physiological functions 50 mg fluvoxamine fast delivery anxiety symptoms 3 weeks, health discount fluvoxamine 100mg with mastercard anxiety zone ms fears, development cheap fluvoxamine 50mg anxiety 300mg, and performance buy discount fluvoxamine 50 mg social anxiety symptoms quiz. Regression models were used to help determine the relationships between school design elements and student performance. The overall outcome expressed variances in achievement when compared to controlled and non-controlled design elements in schools including lighting. Three different schools districts across the nation were chosen to participate in this study. Each school districts? lighting conditions were categorized into several sets of data. A multivariate regression analysis? was used to differentiate the highly variable data for each school district. The statistical evidence revealed that school buildings with the greatest capacity for daylight, such as those with increased window and skylight areas, had a noteworthy effect on students? performance and behavior. Different types of lighting can play different roles in enhancing classroom performance such as improving vision (and perhaps affecting concentration and motivation), behavior, and academic achievement. For example, cool white fluorescent lighting is recommended to aid in reading speed and accuracy and attentiveness or focus. On the other hand, warm white lighting can assist in helping adults to work together and to minimize conflict (Baron, 1992). Children were 20% faster in solving a puzzle together in the relaxed light setting compared to the standard setting. In the energy setting, children talked 95% more than compared to the standard light setting. These results are in line with results of Schulte-Markworth, Barkmann, and Wessolowski (2010, personal communication) who found a non significant small trend towards cooperation under warm light conditions. Additionally, recent research addressing artificial light in school environments has investigated light effects for student achievement (Wolhfarth, 1986), motivation, concentration and cognition (Schulte-Markwort et al. The current study further examined effects of lighting on motivation and concentration revealed by Sleegers et al. Defining Oral Reading Fluency In the most recent edition of the Handbook of Reading Research (2011), Rasinski, Reutzel, Chard, and Linan-Thompson provide the following definition of fluency? a characteristic of reading that occurs when readers? cognitive and linguistic systems are developed to the extent that they can read with sufficient accuracy and rate to allow for understanding the texts and reflecting its prosodic features? (p. According to Rasinski and Samuels (2011), automaticity is the ability of readers to decode words not just accurately but effortlessly or automatically? (p. When readers can read with automaticity, they can devote more cognitive energy to comprehending the text and less to decoding individual words. Kuhn and Rasinski (2011) define prosody as the melodic elements of language that, when taken together, constitute expressive reading? (p. That is, the reader is able to automatically recognize words while providing the appropriate expression implied by the text. Reading rate assessment tools actually measure automaticity with the assumption that readers decoding text rapidly coincides with automatic recognition of words. Measuring prosody is more difficult to measure because it is not as easily quantified. However, these are typically more appropriate for classroom teacher use in order to inform classroom instruction (Rasinski et al. That is, fluency links to phonics via the automatic recognition of words with little cognitive energy expended by the reader. Also, fluency links to comprehension via prosodic reading where text is read with expression. LaBerge and Samuels (1974) introduced the theory of automatic information processing in reading where they argued that surface-level processing of words should occur automatically with little cognitive effort so that readers could concentrate on comprehension. Stanovich (1980) extended this theory in stating that good and poor readers could be characterized by how automatically they recognized words. In addition to the automaticity issue, prosody also correlates to good comprehension (Rasinski, 2004, 2010; Wright, Sherman, & Jones, 2004). These researchers provide evidence of how fluency bridges the gap between phonics and comprehension. Because fluency is an important part of reading instruction and is a major factor in developing reading comprehension, it is important to note the relationship between oral and silent reading fluency. Although fluency is typically thought of as occurring orally, fluency also extends to silent reading. This theory is based on the premise that constructing meaning is the primary goal of reading. The conceptual framework for this study juxtaposes prior research with this study (see Figure 1 for a summary of the conceptual framework of the study in relation to previous research). Dynamic Lighting in the Classroom 1 Artificial Lighting Design and Specifications Light illumination intensity and color temperature are two main variables in lighting systems used for artificial lighting indoors. Light intensity is measured via Lux? and typically 500 lux horizontally on the workplane is the minimum used to create enough illumination for teachers and students to see given the lack of natural light available in classrooms. Color temperature, as measured in Kelvin, refers to the quality of light hue and runs from cool? (blue and white) to warm? (red and yellow) along the radiation spectrum of light. Each lighting fixture (or panel) contains three lamps, with the two outer lamps generating a cool color temperature? and the single inner lamp producing a warm color temperature. Based on this research, the authors conducted the current study utilizing a lighting 1 system, SchoolVision, specifically designed for schools.

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Johnny Dollar went first; he totted up his last expense account and drifted away into whatever limbo waits for retired insurance investigators buy discount fluvoxamine 100 mg on line anxiety symptoms in cats. Their faces and their voices eclipsed the voices which came from the radio discount fluvoxamine 50 mg anxiety joint pain, and even now buy fluvoxamine 50 mg anxiety disorder test, twenty years later cheap fluvoxamine 50mg online anxiety symptoms on dogs, it is the eager, slightly whining voice of Weaver that I associate with Chester Good as he comes hurrying up the Dodge City boardwalk with gimpy enthusiasm, calling, "Mr. A little nostalgia is good for the soul, and I think I have already indulged in mine. But I do want to say something about imagination purely as a tool in the art and science of scaring the crap out of people. You approach the door in the old, deserted house, and you hear something scratching at it. The audience holds its breath along with the protagonist as she/he (more often she) approaches that door. The audience screams, but this particular scream has an oddly relieved sound to it. The heroine (Trish Van Devere) has rushed off to the haunted house her new friend (George C. Scott is not there at all, but a series of small, stealthy sounds leads her to believe that he is. The audience watches, mesmerized, as Trish climbs to the second floor; the third floor; and finally she negotiates the narrow, cobwebby steps leading to the attic room where a young boy has been murdered in particularly nasty fashion some eighty years before. The audience screams as the empty wheelchair chases the lady, but the real scare has already happened; it comes as the camera dwells on those long, shadowy staircases, as we try to imagine walking up those stairs toward some as-yet-unseen horror waiting to happen. Bill Nolan was speaking as a screenwriter when he offered the example of the big b,-g behind the door, but the point applies to all media. And because of this, comes the paradox: the artistic work of horror is almost always a disappointment. You can scare people with the unknown for a long, long time (the classic example, as Bill Nolan also pointed out, is the Jacques Tourneur film with Dana Andrews, Curse of the Demon), but sooner or later, as in poker, you have to turn your down cards up. And if what happens to be behind it is a bug, not ten but a hundred feet tall, the audience heaves a sigh of relief (or utters a scream of relief) and thinks, "A bug a hundred feet tall is pretty horrible, but I can deal with that. There is and always has been a school of horror writers (I am not among them) who believe that the way to beat this rap is to never open the door at all. The film and the book do not differ greatly in terms of plot, but they differ significantly, I think, in terms of thrust, point of view, and final effect. In it, an anthropologist (Richard Johnson) whose hobby is ghost hunting invites a party of three to summer with him at the infamous Hill House, where any number of nasty things have occurred in the past and where, from time to time, ghosts may (or may not) have been seen. Dudley, offers each her simple, bone-chilling catechism as they arrive: "No one lives any closer than town; no one will come any closer than that. The four of them experience a steadily escalating run of horrors, and happy-go-lucky Luke ends by saying that the property he has so looked forward to inheriting should be burned flat. For our purposes here, the interesting thing lies in the fact that we never actually see whatever it is that haunts Hill House. And most apropos to where we are now, this same something causes a door to bulge grotesquely inward until it looks like a great convex bubble?a sight so unusual to the eye that the mind reacts with horror. I see it?coming here?hell-wind?titan blur?black wings?Yog-Sothoth save me?the three-lobed burning eye. I think both Wise and Lovecraft before him understood that to open the door, in ninety-nine cases out of a hundred, is to destroy the unified, dreamlike effect of the best horror. There is (or may be), after all, that hundredth case, and there is the whole concept of suspension of disbelief. The exciting thing about radio at its best was that it bypassed the whole question of whether to open the door or leave it closed. For the listeners during the years 1930 to 1950 or so, there were no visual expectations to fulfill in their set of reality. Randolph is trapped in a deserted basement swimming pool while, somewhere nearby and getting closer all the time, a great jungle cat menaces her. In the other sequence, she is walking through Central Park and the cat is getting closer and closer. Randolph steps onto it, leaving the audience limp with relief and with the feeling that a horrible disaster has been averted by inches. At the base of the myth of the cat people?werecats, if you like?is a deep sexual fear; Irena (Ms. Simon) has been convinced as a child that any outpouring of passion will cause her to change into a cat. Lewton, like Stanley Kubrick with the Shining, is the master of context here, lighting the scene to perfection and controlling every variable. We feel the truth of that scene everywhere, from the tiled walls, the lap of the water in the pool, to that slightly flat echo when Ms. And I am sure the Central Park scene worked for audiences of the forties, but today it simply will not wash; even out in the sticks, audiences would hoot and laugh at it. I finally saw the movie as an adult, and puzzled for some time over what all the shouting could have been about. So instead of shooting in daylight with a heavy filter, a technique that shows up as even more glaringly faked, Tourneur quite sensibly opted for the soundstage?and it is interesting to me that, some forty years later, Stanley Kubrick did exactly the same thing withThe Shining. To theatrical audiences of the time there was no false note in this; they were used to integrating movie sets into their imaginative processes.

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In the noospheric analysis order fluvoxamine 100 mg amex anxiety symptoms going crazy, the Inevitable Event was the suicide of the technosphere unable to fluvoxamine 100 mg lowest price anxiety symptoms change over time sustain two clashing time programs buy 50 mg fluvoxamine with amex anxiety grounding. It was a program of the strict Islamic twelve-month lunar calendar that drove its belief system into the Twin Towers and the Pentagon cheap 50mg fluvoxamine amex anxiety natural supplements, the two supreme monuments of the program of the twelve unevenly measured months of the Gregorian pseudosolar calendar. We know where the Vatican, the bastion of Christendom, is and who ordained the Gregorian calendar, but what do we know about Islam? It is the last whole revealed text for all hu manity, received and recorded over a 23-year period by a single human being, Muhammad the prophet (570-632). While militant Muslims and terrorists have dominated the mass media image ofIslam for the past few decades, what is the Quran and what does it actually teach? It is also a function of the Gregorian program that scarcely anyone in the West really knows or is familiar with the Quran, since the West has been at odds with Islam since the time of Muhammad. As the supreme text of monotheism, the Quran is actually a psychoactive book that upholds Islam as the final religion for humanity. I 03 guidance and the religion of truth, to make it prevail over all other religions. The biosphere is Islam, or "peace, which is submission to the will of God," understood as the divine law of nature. In the creation of the heavens and the earth, the alternation of night and day, the ships that roam the ocean for the benefit of the people, the water that God sends down from the sky to revive dead land and to spread in it all kinds of creatures, the manipulation of the winds, and the clouds that are placed between the sky and the earth, there are sufficient proofs for people who understand. And he created the livestock for you, to provide you with warmth and many other ben efits as well as food. And they carry your loads to lands that you could not reach with out a great hardship. With it, He grows for you crops, olives, date palms, grapes, and all kinds of fruits. And you see the ships roaming it for your commercial ben efits, as you seek His bounties, that you may be appreciative. The Solution of the Law of Time ers (mountains) on earth lest it tumbles with you, as well as rivers and roads that you may be guided. And we send the winds as pollina tors, and cause water to come down from the sky for you to drink. From the Quranic perspective, human freedom of choice is at the root of the bio spheric destruction. Choosing anything but to be submissive to God, the human is in rebellion against nature-both his own and that of the biosphere. He [God] thus lets them taste the consequences of some of their works, that they may return [to the right works]. The forces that created the phenomenon of historical Islam are the enclosing of the Holy Quran within the rigid system of a twelve-month, non-circulating lunar calendar, compounded and supported by the development of the hadith and sunna (non-Quranic) traditions. A profoundly conservative social order, Islam is nonethe less activated and motivated by a holy scripture that enunciates an attitude toward nature that is the direct opposite of the 12:60 system that produced the technosphere. In this regard, the precepts of the Holy Quran-as of many another holy scripture make it the "enemy" of the technosphere. From the noospheric perspective, histori cally and culturally, however, the assault on the nerve centers of the techno sphere the Solution of the Lawof Time. I 05 could only have been effected by humans whose belief system was rooted in the Holy Quran, which had been at odds with the Gregorian civilization for centuries. But only if man consciously chooses the right return path: synchronized harmony in time. The problem is not so much the rigid lunar calendar ofIslam, but the irregular global standard of the Gregorian calendar, which, instead of standardizing all mea sures and perceptions of time, fosters a human social disharmony and an incessant antagonism against nature-and against Islam. Humanity must take a long, hard look at its own timing systems and scrap what needs to be scrapped, no matter what kind of temporary inconveniences this may cause. Yet it is the only method that has not been commonly tried and the only step that has not yet been collectively taken. It is a characteristic of the dominant mind set that it writes history in the way that suits its own needs and supports its philoso phy. In any of the reviews of the century carried by the mass media during the past year, you will find no mention of the World Calendar Reform Movement; nor will you find, for instance, any mention of the Roerich Peace Pact (1935); nor of the Harmonic Convergence-all buried by the marketing of history to suit the needs of globalization. A concern for peace based on an understanding that without harmony, the human cultural situa tion will only worsen. If humankind suffers from an excess of disharmony, in the noospheric analysis the only solution is a harmonic standard of time to synchronize all humanity simultaneously-the Law of Time refers to this as the Thirteen Moon! TheSolutionof the Lawof Time radically that the way in which people think will itself be dramatically changed. This is the meaning of the replacement of the Gregorian calendar by the Thirteen Moon calendar. The calendar change is necessary because, as the pragmatic application of the discovery of the Law of Time, it brings into focus the essence of this discovery: Time is a frequency, the frequency of synchronization. If a calendar does not in crease synchronization, it is not performing its highest function. This is the funda mental critique of the Gregorian calendar-and of all concepts of time based solely on physical, third-dimensional astronomical measurements. This discovery is so new and startling that it affects all human thought and is a matter to which all belief systems, religions, and methods of science must be cognizant. Yet nothing, it seems, is more difficult for humanity than to make this change from a manifest disharmony to a manifest harmony. This is because historical man defines his existence and thrives upon the dis harmonies of his own invented time. The Gregorian calendar keeps the human mind entrained in a diabolical disorder of meaninglessly named months of uneven mea sure, while every day is tracked and driven by a relentless mechanism called a clock. This immersion of the mind of historical man in the frequency of his own artificial time, more than any other factor, condemns him to a world of inescapable horrors: traffic jams, poverty, terrorism, unresolvable historical and territorial disputes, glo bal warming, environmental degradation, social disorder, insanity, and drug abuse.